Valdez, Gianni Marie Demejes, Beryl Ann Taupa, Monica Jane Mendoza, Hazel Benfit, Cali

The

evaluation of teeth to be restored should include these endodontic considerations:

(1) the

health of the root canal sys- tem, (2) the impact of planned restorative procedures on the pulp, and (3) the magnitude of the restorative effort.

1.

2.

3. 4.

5.
6.

Adequate obturation of the root canal system No sensitivity to percussion or biting pressure No sensitivity to palpation No sinus tract No periodontal probing deeper than 3mm No evidence of active inflammatory disease

 Restorations

for endodontically treated teeth are designed to replace the missing tooth structure and to protect the remaining tooth structure from fracture. The final restoration will include some combination of: o dowel o core o coronal restoration.

The

selection of the individual components for the resto- ration depends on whether the nonvital tooth is an anterior or posterior tooth and whether significant coronal tooth structure is missing

Nonvital anterior teeth that have not lost tooth structure beyond the endodontic access preparation are at minimal risk for fracture and do not require a crown, core, or dowel. Restorative treatment (amalgam or composite) is limited to sealing of the access cavity.

 When

a nonvital anterior or posterior tooth has lost signifi- cant tooth structure, a cast coronal restoration is required. An intermediary restoration, the dowel and core, is used to support and retain the crown.

 The

dowel and core function together. The core replaces lost coronal tooth structure and provides retention for the crown. The dowel provides retention for the restorative material of the core and must be designed to minimize the potential for root fracture from functional forces. The crown restores function and esthetics and protects the remaining root and coronal struc- ture from fracture.

 The

dowel is a metal post or rigid restorative material placed in the radicular portion of a nonvital tooth.

It functions primarily to aid retention of the restoration and secondarily to distribute forces along the length of the root. The dowel thus has a retentive role but does not strengthen a tooth. Instead, the tooth is weakened if dentin is sacrificed to facilitate larger dowel placement..

 The

core consists of restorative material placed in the coronal area of a tooth. This material replaces carious, fractured, or otherwise missing coronal structure and retains the final coronal restoration. The core and dowel are usually fabricated of different materials:
o Cast Core o Amalgam Core o Composite resin Core o Glass-ionomer

o Coronal-Radicular Core

Dowels can be cemented with:

o zinc phosphate cement,
o glass ionomer cement, or o resin cements. Zinc phosphate cement is a traditional dental luting agent with a long and satisfactory clinical history. It provides reten- tion through interlocking of small mechanical undercuts in the tooth structure and restorative materials. The retention is suf- ficient for welldesigned dowels, cores, and coronal restoration of the endodontically treated tooth.The inability to chemically bond to residual tooth struc- ture is also a disadvantage.

Adhesive and resin cements differ from zinc phosphate in that they bond to tooth structure and to most dowel materials. This gives an added dimension to the luting agents used for dowel and core restorations. Glass ionomer cement bonds to dentin within the root and becomes incorporated into a glass ionomer core, forming a homogeneous unit. The anticariogenic effect of glass ionomer materials is a major advantage. The retention is similar to that of zinc phosphate cements, for a given dowel length and design.

investigators used radiographic and clinical findings to evaluate treatment results. Clinical evaluation often relics on subjective findings, such as report of pain or discomfort upon percussion, that are subject to individual variation. However, resorting to only a radiographic evaluation may allow pathosis that is clinically evident but produces no radiographic manifestation to be overlooked
Most

 The

causes of endodontic failures have been classified dif- ferently by several authorities. Grossman divided the causes into four categories:

o poor diagnosis,

o poor prognosis,
o technical difficulties, and

 Endodontic

failure cases may be treated in either of two ways:

o retreatment o surgery.

Surgery may include extraction of the tooth, resection, or hemisection of a root all of which mean removal of the failed tooth or root without attempting to treat it. Surgery may also be used to correct endodontic failures by apical curettage, apicocctomy, and ret- rofitting of the root canals.